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Transanal one-stage endorectal pull-through for Hirschsprung's disease: a multicenter study.

Abstract：

BACKGROUND/PURPOSE:Transanal endorectal pull-through (TEPT) is the latest development in treatment of Hirschsprung's disease (HD). This prospective study was designed to evaluate the safety and efficacy of 1 stage TEPT technique in the management of patients with HD. METHODS:One hundred forty-nine children (116 boys and 33 girls) aged 8 days to 14 years underwent 1 stage TEPT procedure over an 18-month period at 5 Egyptian academic pediatric surgical centers and affiliated hospitals. Median follow-up was 12 months (range, 3 to 21 months). These patients were evaluated with regard to age, sex, length of the aganglionic segment, intraoperative details, and postoperative functional results or complications. An electromyogram (EMG), endorectal ultrasound scan, and lower gastrointestinal (GI) motility studies were reserved for patients with postoperative problems with bowel control. RESULTS:Mean operating time was 120.2 +/- 27.8 minutes (range, 60 to 210 minutes). The average length of resected bowel was 26.8 +/- 12.4 cm (range, 15 to 45 cm). Thirteen patients required laparotomy because of extension of aganglionic segment beyond the sigmoid colon in 9, tear in the mesenteric vessels in 2, and difficulties in getting to the submucosal plane in 2. Three deaths (2%) occurred 3 days, 4 days, and 4 weeks postoperatively, respectively. Postoperative complications included transient perianal excoriation in 48 patients (30 were <3 months of age), enterocolitis (n = 26), anastomotic stricture (n = 7), recurrent constipation (n = 6), hypoganglionosis at distal end of pulled through segment (n = 2), cuff abscess (n = 3), anastomotic leak (n = 1), adhesive bowel obstruction (n = 1), and rectal prolapse (n = 1). Complete anorectal continence was noted in 35 of 42 (83.3%) children older than 3 years, whereas soiling and frequent accidents still occur in 7, who showed a steady improvement in their continence status. CONCLUSIONS:One-stage TEPT technique is both feasible and safe technique in properly selected children with rectosigmoid HD in all ages. The technique is easily learned and is associated with excellent clinical results.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Elhalaby EA,Hashish A,Elbarbary MM,Soliman HA,Wishahy MK,Elkholy A,Abdelhay S,Elbehery M,Halawa N,Gobran T,Shehata S,Elkhouly N,Hamza AF

doi

10.1016/j.jpedsurg.2003.11.038

subject

Has Abstract

pub_date

2004-03-01 00:00:00

pages

345-51; discussion 345-51

issue

eissn

0022-3468

issn

1531-5037

pii

S0022346803008960

journal_volume

pub_type

临床试验,杂志文章,多中心研究

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Transanal one-stage endorectal pull-through for Hirschsprung's disease: a multicenter study.